After reviewing a patient’s hospital discharge report that indicated use of fentanyl when the patient only claimed to have smoked crack cocaine, Rhiannon Thomas, a coordinator at Toronto’s South Riverdale Community Health Centre, warned CBC Radio’s Metro Morning that the city’s supply of crack cocaine may in fact be laced with the deadly opioid. And while it may not be a regular occurrence, and the contamination could be accidental, Thomas also attributes at least seven recent overdose deaths in Toronto to users unknowingly ingesting fentanyl while smoking crack. “The word needs to get out very quickly,” she warned. “Two weeks or three weeks later is too late.”

When asked to confirm the cause of these overdoses, Toronto Public Health was unable to state that fentanyl was the cause, but has said that more information will be forthcoming.

Since 2012, the amount of fentanyl within cocaine apprehended by the Canada Border Services Agency, Canadian police, and the Correctional Service of Canada and subsequently tested by Health Canada’s Drug Analysis Service has risen from 0.01% to 1.8%.

At this time, crack cocaine users are prohibited from smoking crack cocaine within overdose prevention sites, and the safe injection site at Moss Park is the only site in Toronto that provides a smoking tent.

Thomas advises drug users to carry naloxone, which reverses the effects of an overdose, and says it is “very easy to use.” She encourages communication about drug use, and suggests that people not use illicit drugs alone. She believes that the only way to keep fentanyl out of street drugs is to decriminalize illicit drugs across Canada.

“People are using drugs whether you like it or not,” she said.

At the end of February, a federally sanctioned safe drug consumption site will open in Lethbridge, Alberta, which will allow inhalation and smoking, and thus be open to users of crack cocaine.